baptist health system - fhacollab.fha.org/files/scoxwell_readmcollabmtg_10-16-09.pdf · baptist...

Baptist Health SystemJacksonville, FL

Baptist Health System

Five (5) Hospital System

– Serving greater Jacksonville area and SE Georgia

– Children’s Hospital

Community Leader in Healthcare

– Children’s Hospital

• Primary Care Facilities throughout the community

• Outpatient Centers

– Jacksonville Orthopedic Institute

– Baptist Eye Institute

– Baptist Cancer Institute

Baptist Health SystemBaptist Medical Center - Downtown

439 Bed Facility – 462 Acute

Baptist Health SystemBaptist Medical Center - Beaches

146 Bed Facility

Baptist Health SystemBaptist Medical Center - Nassau

54 Bed Facility

Baptist Health SystemBaptist Medical Center - South


Baptist Health SystemWolfson Children’s Hospital


Hospital Compare

Sharing Results With The Board

Top 5 Readmission APR-DRGs within the Baptist Health System

Beaches Downtown South

HEART FAILURE (194)

CARD ARRHYTHMIA & CONDUCTN DIS (201)

OTHER PNEUMONIA (139)

HEART FAILURE (194)

SCHIZOPHRENIA (750)

CHRONIC OBSTRUCTIVE PULM DIS (140)OTHER PNEUMONIA (139)

CHRONIC OBSTRUCTIVE PULM DIS (140)

KIDNEY/URIN TRACT INFECT (463)

Nassau


HEART FAILURE (194)


KIDNEY/URIN TRACT INFECT (463)

RENAL FAILURE (460)


MAJOR DEPRESSIVE DISORDER (751)

WolfsonAPR-DRG


CHEMOTHERAPY (693)

FEVER (722)

CHEMOTHERAPY (693)

MAJ HEMATOLOGIC/IMMUNOL DX (660)

NEO BW >2499G NORM NB/OTH PROB (640)

SICKLE CELL ANEMIA CRISIS (662)


Baptist Health System

Necessities:• Administrative and Board Support

– Commitment to Quality

– Readmission Focus 2010

• Structure for Quality• Structure for Quality– Advanced Practice Partners

– Educators at Bedside

– Clinical Effectiveness / Performance Improvement Nurses

– Concurrent Clinical Data Abstractors (nurses)

– Collaboration with home health agencies, community organizations, internal support (social services, information services, etc.)

• Operational Performance Improvement

FHA Readmit Survey 2009At Time of Admission &

Improving Patient/Caregiver Understanding

x x x x x

x x x x

x x x x x x

Initiative

At Time of Admission Reliably Effective Implemented Underway Under Construction Not a Focus Area

Evaluating end-of-life issues for discharge planning

Assessing risk for readmission

Reconciling medications at time of admission

Beaches Downtown Nassau South Wolfson

x x x x x x

x x x x x

x x x x x

x x x x x

x x x x x

Improving Patient/Caregiver Understanding Reliably Effective Implemented

Enhancing patient/caregiver education (such as

“teach back”) on the patient’s condition and how to

manage

Underway Under Construction Not a Focus Area

Providing emergency contact number to call with

questions

Developing patient education tools such as

calendars, reminders, disease specific information

Determining the primary caregiver and discharge

needs

Evaluating end-of-life issues for discharge planning

FHA Readmit Survey 2009Improving the Discharge Process

x x x x x

x x x x x

x x x x x

Improving the Discharge Process Reliably Effective Implemented Underway Under Construction Not a Focus Area

Revising/standardizing discharge materials and

instructions

Using a discharge coach

Standardizing the discharge process to ensure

consistency 24/7


x x x x x x

x x x x x

x x x x x

x x x x x

x x x x xProviding equipment to help manage condition (i.e.

scale to weigh)

Arranging for timely follow-up by a physician or

nurse based on readmission risk

Reconciling medications at discharge

Assessing readmission risk and/or the need for

home care referral

Improving transfer processes and communications

between care settings and providers

FHA Readmit Survey 2009Improving the Discharge Process

x x x x x

x x x x x

x x x x x

x x x x ?

Post-Discharge Follow-up Reliably Effective Implemented Underway Under Construction

Providing specific information when and where to

call for help

Conducting post-discharge phone calls by RN to

patient

Not a Focus Area

Providing home medication reconciliation, either

remotely or in person

Determining patient follow-up rates with PCP


x x x x ?

x x x x x

x x x x x

x x x x x x

x x x x x

x x x x xImplementing collaborative relationships with PCPs

Standardizing bi-directional transfer information

among long-term care providers

Improving coordination and communication with

post-acute providers/care settings

Monitoring patients remotely through telemedicine,

monitors or other means

Determining discharge summary/abstract availability

for physician or nurse follow-up

remotely or in person

Differences Matter

Beaches Downtown Nassau SouthMedicare (45.3) Commercial (42) Medicare (45.5) Commercial (48.1)

Commercial (34.6) Medicare (36.6) Commercial (24.3) Medicare (36.5)

Self Pay/Uninsured (8.8) Self Pay/Uninsured (9.3) Medicaid (16.5) Medicaid (6.9)

Medicaid (7.9) Medicaid (9) Self Pay/Uninsured (10.3) Self Pay/Uninsured (6.3)Other (3.3) Other (3.3) Other (3.5) Other (2.2)

• Hospital located in • Only hospital in Nassau • Centrally located in • Located in Jacksonville • Hospital located in

predominantly middle,

upper middle class area

• Younger patient

population and older

patient population

• Several Skilled Nursing

Facilities in close proximity

• Only hospital in Nassau

County – rural areas, lower

and middle class

populations, small segment

of upper class on “the

Island”

• Skilled Nursing Facility

across the street

• Centrally located in

metropolitan area – full

service hospital

• Only private children’s

hospital in NE Florida and

Southern Georgia

• Wide variety of

populations

• Receives patients from

Southern Georgia hospitals

• “Indigent hospital” across

the river

• Located in Jacksonville

Beach

• Wide range in population

– homeless to upper class

One Size Doesn’t Fit All

One-size-fits-all health plan makes little sense

June O'Neill, Commentary

Metro Phoenix's East Valley region

Thursday, Oct 15, 2009| 6:03 pm

July 31, 2009 - 3:03PM

“At President Obama's request, Congress is rushing to produce a plan that promises

both medical coverage and high-quality health care for all Americans. But

nationalization of the way 250 million non-elderly Americans receive medical care

should not be taken lightly. Such efforts could create relentless cost pressures, and

in turn, a decline in the quality of medical care that most Americans take for

granted.”

Tools

• Admission History and Assessment

– Paper and electronic

• Electronic advantages

• Medication Reconciliation• Medication Reconciliation

– Multiple revisions in paper

– Started on admission

• Electronic fires tasks to nursing until it is completed

Electronic vs. Paper

• Baptist Downtown and Wolfson Children’s Hospital – Paper – tentative go live date in 24 months.

• Baptist Beaches, Nassau and South –Electronic Medical Record

Electronic Discharge ProcessPart 1

Paper Discharge Instructions

• Four (5) Discharge Instruction Forms

– Adult

• Medical/Surgical Discharge Instructions

• Cardiac Discharge Instructions• Cardiac Discharge Instructions

• Cardiac Surgery Discharge Instructions

• Behavioral Health Discharge Instructions

– Children

• Discharge Instructions

• Multidisciplinary Discharge Instructions

Reaching Out…

• Continuum of Care

– Primary Care Physicians

– Home Health

– Skilled Nursing and Assisted Living – Skilled Nursing and Assisted Living Facilities

– Community Agencies

Num

ber

of

Ho

spit

al A

cquir

ed (

HA

PU

, F

alls

or

BS

I)

30

40

50

System-wide Incidents of (Pressure Ulcers, Falls or CR-BSI)Date Range of Data

Sharing Results With StaffN

um

ber

of

Ho

spit

al A

cquir

ed (

HA

PU

, F

alls

or

BS

I)

1 1 1333 58

6760

10

20

Oct

'08

Nov

'08

Dec

'08

Jan

'09

Feb

'09

Mar

'09

Apr

'09

May

'09

Jun

'09

Jul

'09

Aug

'09

Monthly

Target

Target = FY2009 Catheter-related Blood Stream Infections Annual Target divided by 12

months

Sharing Results With The Board

Internal

FY07

Internal

FY08

Internal

FY09

Y-T-D

1st

Quarter

Oct'08

--

Dec'08

2nd

Quarter

Jan'09

--

Mar'09

3rd

Quarter

Apr'09

--

June'09

4th

Quarter

July'09

--

Sept'09

Current

Quarter

Comparison

to Target /

Benchmark

Trend

B-Pr

B-Pr

B-Pr

Effectiveness

Coronary artery bypass graft patients -

mortality rate (w/ and w/o cardiac catheterization).

Congestive heart failure (CHF) - readmission rate.

Community acquired pneumonia - readmission rate.

Privileged and Confidential

This Baptist Health document

is not subject to discovery

pursuant to Florida statutes.

Comparator

Baptist Medical Center Downtown Clinical Overview Dashboard

As of Q3 FY2009

Fiscal Year 2009 Ranking

Key Performance

Indicator Target

- - -

Benchmark

- - -

Internal BenchmarkMeasure

B-Pr

B-Pr

B-Pr

iB

-- --

-- --

iB

iB

T

T

Footnotes and Legend

Knee replacement - readmission rate.Effectiveness

Neurosurgical invertebral disc excision

complication rate.

Unplanned returns to the OR per 1,000 OR patients

(inpatients and outpatients).

Acute myocardial infarction (AMI) -

readmission rate.

Post operative surgical infection rate per 100

inpatients having surgical procedures .

B Benchmark iB Internal benchmark

Patient falls per 1,000 adjusted patient days.

Catheter-acquired bloodstream infection rate

per 1,000 patient bed days.

Post operative PE (Pulmonary Embolism) or DVT

(Deep Vein Thrombosis) rate per 1,000 pts at risk.

Desirable upward trend. Undesirable downward trend.

Case volume < 5 (too low for meaningful reporting).

x=numerator, y=denominator.

Patient Bed Days – The count of unique patient bed-contact days. The count is incremented

every time a unique patient occupies a bed during a day. Example: Day 1, Patient X is moved

from bed 101 to bed 402. Patient Y is moved into bed 101. Without any other changes, the

Day 1 patient bed day count is equal to 3. The source of this data is a canned report in SMS.

Below target or benchmark; limited or no progress. Undesirable upward trend.

Patient Safety

-Pr Premier Clinical Advisor databaseAt or exceeding target or benchmark.

Near target or benchmark; active progress.

Desirable downward trend.

Static or no discernable trend.

T Target

Code 15s.

Medication variances

X y

Questions?Carolyn Mueller, RN, BSN

Sr. Clinical Data Abstractor

baptist health system - fhacollab.fha.org/files/scoxwell_readmcollabmtg_10-16-09.pdf · baptist...

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